Early on, they’re often caused by volume loss in the face, especially some of that 20% of skull mass that we eventually (and quite normally) lose over our lives. This is how it works:

There’s a little ligament, about ½ inch wide, on each side of the chin just where those “marionette lines” form. It’s very tight between the bone and the skin – and it stays tight as our skull starts to become smaller, a process that generally begins after about age 25. This is mostly what creates that first indentation of a marionette line and also the indentation on either side of our chin at the jawline that makes the area just next to it look like a jowl. This is what we call a “pseudo-jowl” and it usually can be smoothed out nicely with a filler.

As we proceed to age not only does that process continue, but we also accumulate some fat at the jowl, and other tissues stretch and slide down to form a real, live standard issue, pseudo-no-more jowl.

Sometimes people attempt to keep filling the indentation up as the jowl enlarges. That’s when the face can look boxy and distorted – we’ve all seen it – because the actual cause hasn’t been addressed. This is when gravity has superseded the volume loss issue and a facelift is indicated. The volume still needs to be addressed or people can look windblown, but the important thing is for your doctor to know the difference, address the proper condition and do it safely, skillfully and with artistic vision.

If you need help deciding between a facelift or fillers, click here to contact us for an appointment.

1.You have significant vertical “bands’ at your neck.These bands, sometimes called a “turkey wattle”, are the edges of a neck muscle (the platysma muscle). If the bands are very small, sometimes they can be kept at bay with BoTox, Pelleve or Ulthera, daily passive stretching of the neck or a combination of these; however, most of the time they require surgery to fix them definitively.

2.Your general facial shape looks as though it’s shifted from oval or heart-shaped to square over the years.This is gravity at work, and a good facelift will shift that contour change back so the fullness is through the midface and not hanging from your jawbone.

3.Your skin is in good shape and it’s the falling of the lower face and neck that’s the problem, not wrinkles.No matter what misleading advertisements you may have seen, a facelift is not going to change your skin texture, at least not after the initial swelling has gone away. That’s what lights and lasers are for – shrinking and resurfacing the skin – and rebuilding collagen and elastin. Wrinkles occur from DNA changes in the skin along with breaking down of the collagen and elastin. Surgery with a scalpel won’t change the skin. A lift is exactly that – it will pick up what has fallen down, but it won’t alter the make-up of your skin.

4.When you cup your hands under your chin (so the wrists meet), place your fingers on the sides of you face and then lift up gently, you look much better. Don’t worry about the wrinkles you push into being at the sides of your eyes. You’re pushing; a facelift is shaped from the inside out and nothing is pushed, so unless your skin has lost its elasticity (see above), a well-performed lift won’t leave you with more wrinkles there than you had before the lift (although a bad one certainly can).

5.Generally, you’re at least 45 years old, and more likely over 50.Nothing is without exceptions, and genetics and lifestyle choices can always throw off the norms. That said, I’ve seen way too many women in their early 40’s (one was even 36!) who had been advised by plastic surgeons that they needed facelifts when all that was going on was some volume loss. On the other hand, I’ve seen a lot of women long past their forties who really needed facelifts, but they had been pumped up with fillers until they looked stuffed. (See my blog, Jowls: Facelift or Fillers?)

If you think you might benefit from a facelift, look at these five indications and then have an evaluation by someone with the skill, the artistic vision and the integrity to advise you properly and make you your most beautiful. Click here to contact us for an evaluation appointment.

Bring us a photo of anything you’ve mothered – a child, a pet, a plant, your own parents – and we’ll honor you with a FREE ($150 value) IPL treatment for your busy hands when you purchase a full face IPL treatment.

IPL (Intense Pulsed Light) is the ideal way to eliminate age spots and small red blood vessels from anywhere on the body and get smoother, silkier skin as a side effect!

Call us today at 941.951.2220 and get your very own Mother’s Day treat, from now until the end of May!

Q. Sally asks: I read your article about why eyes may get smaller as we age. Can you explain how I should insert and remove my contact lenses?

A. The best way to insert soft contact lenses is to place them without stretching the eyelids. The best way to do this is as follows: Place the contact near the tip of your index finger. Make sure it's not too wet - this will allow it to grab onto your eye and not stick on your fingertip when you're trying to insert it. Get in front of a mirror and brace your third or fourth finger on your cheek without pulling down on your eyelid.

Tuck your chin down while looking up into the mirror so you've exposed as much white at the lower part of your eye as possible. Let the contact touch the lower part of the eye and as soon as it "grabs" look up as high as you can (you won't be able to see yourself at this point) and roll your fingertip up slightly to allow the top of the contact to seal onto your eye. It's really easy once you get the hang of it, and it's not that much different than the way people normally insert CL's.

To remove the contact, place the sides of the pads of your fourth fingers together, place them over your contact, and then pinch the pads together a bit to break the seal of the contact with your eye. This way, you can put them in and take them out day after day and year after year without ending up with a saggy lower lid margin down the road.

Q. Sally also noted that her eyes seemed smaller since she began wearing contact lenses about a year ago. Here was my reply:

A. If your eyes seem smaller since you began wearing contact lenses, it may be that the eyes are a little dry. When the eyes are dry we sometimes squint a bit in an unconscious effort to reduce their exposure to the air. If that's the case, you may want to try a contact lens solution that is moisturizing. Opti-Free Replenish is a great solution (no pun intended) for the drying effects of contact lenses. Other than that, contacts should have no effect on the size of your eyes.

The newest Juvederm product, Voluma has been FDA-approved for use in restoring volume in the cheek area. Voluma has been shown to last up to 2 years.

If you loved Juvederm, you will love Juvederm Voluma even more! Voluma is made of hyaluronic acid (HA), a naturally occurring sugar in the body. In large part, the longevity of HA fillers has been determined by the amount of "cross-linking" of the molecules, meaning essentially how densely they're packed together. Voluma is highly cross-linked, to the point where the density of the filler allows it to last up to two years. This added density has not detracted from the smooth, silky way it goes into the face, but (aside from the fact that there is 20% more product in each syringe than there was with Juvederm's former incarnations) Voluma is definitely creating more fullness just from the density alone.

HOW TO MAKE YOUR FACE LOOK INSTANTLY YOUNGER WITH CONTRAST

PART 2: EYES AND LIDS

As children, most of us have lips with a rosy cherubic color. As the decades pass, the lips tend to fade in color and the contrast between the border of the lips and the skin around the lips becomes less defined. With the loss of definition the border can become irregular and any asymmetries in the contour of the lip borders can appear exaggerated.

This is where lip liner comes in. A "lip-colored" lip liner allows you to restore that border, smoothing its contour and restoring the contrast between the rosiness of natural young lips and the skin outside of the lip line. Keep the lip liner close to your natural lip color or the lip color you're applying that day. Lip liner that is more than a shade darker than your lip color will look artificial and harsh. While you can "push" the border a little bit if you want the look of more volume, it's important to keep the lip liner from going onto the flat part of the lip outside the border.

If you feel that you've lost so much volume in the lips that enhancing them with lipstick or liner is an exercise in futility, I can restore the volume of the lips with a very long-lasting technique that will look beautifully natural. With all the overdone and "trout-mouth" lips that frighten people out of restoring lost volume, the fact remains that those results absolutely never need to happen. The difference between a disaster or even mediocrity and a beautifully restored lip requires:

1. An in-depth understanding of the anatomy and embryonic development of the lips and the area around them, 2. Impeccable technique, 3. Commitment, 4. Experience, 5. The correct product to restore the lips and 6. Artistic skill to sculpt a beautiful and natural-looking lip while correcting asymmetries.

"I was out to dinner with a few friends and they were talking about how awful those filled-up lips looked. They were saying they'd never have it done. Then one of my friends turned to me and said how lucky I was that I didn't need it. I just smiled."--As related to Dr. Barbour by an actual patient whose lips she had restored.

How to Make Your Face Look Instantly Younger With Contrast

Part 1: Cheeks and Brows

In previous entries with this title, we covered attitude -- because your outer beauty is a reflection of your inner beauty. Now here's something that can be dealt with in a minute and an issue I see with women on a consistent basis. One of the quickest and easiest ways to make your face look healthier (and therefore younger) is with contrast. A monochromatic face is much more likely to look tired than a face with contrasts of light and dark and contrasts of color. Given that we all know that you never want to take any of this to extremes, contrast immediately provides a lift to the face, so here are a couple tips:

1. My newer patients often will come in having used an allover bronzer (we are, after all, in Florida down here) to give the face a bit of tan. That's fine. A little bronzer can warm up a face really nicely. But if you're going to use it all over the face, you then need to give yourself a flush of color on the apples of the cheeks. Better yet, you can put a touch of that color across the bridge of your nose and the tip of your chin to mimic the flush of a young person who's just come in from a good run. Bronzer placed evenly over the face without a pop of color at the cheeks can look flat or even muddy. Another thing you can try is simply using the bronzer where you would put a blusher and leaving the rest of the face its natural color. Remember though, that subconsciously the observer will read a bit of pink at the cheeks as good blood circulation. Good circulation indicates health and the look of health is appealing to an observer. If you're going to make a choice between only bronzer or only blusher, almost always the blusher will give a healthier look than bronzer alone.

2. As we age, our eyebrows tend to become thinner and lighter in color. Since it's a gradual process, our eye adjusts to it so it looks normal to us, and sometimes we continue to pluck until there's not much left but a thin line. One of the indicators of youth is a full brow with good color, again within reason. Most of us (who are female) can't carry off a really heavy brow. But a full healthy one looks so much younger -- and healthier -- than a skinny line. Generally, brunettes and deep redheads require a brow color slightly lighter in value than their hair color. Blondes and lighter redheads should go with a color that is slightly darker than their hair color. A pale or disappearing brow is to your eyes like a house without a roof. Brows frame the eyes and direct the observer's eyes to yours. When you first change the brows, it may take you a little while to adjust to the new look, but almost inevitably a full healthy brow with good color contrast against the skin is going to make you look more attractive.

As always, you're welcome to call us for an evaluation at 941.951.2220. Jill, our aesthetician (who looks like a fresh little meadow maid herself -- and amazingly young) can show you exactly what to do using our good-for-you and absolutely beautiful Jane Iredale cosmetics. Stay tuned. In the next blog we'll go over this topic as it applies to your eyes and then later we'll talk about your lips.

There is a growing number of quantum physicists who theorize that thoughts actually may have mass, and there are corollaries called "field theory" and "morphogenic fields" postulating that thoughts may have a physical effect on us and our world. Additionally, there is a striking collection of experiments and anecdotal reports that support these theories. What can we take away from that in our talk about aging? We can at least suspect that a positive attitude, treating others the way we would want others to treat us, an outlook of cooperation rather than competition, and well-developed senses of compassion and empathy may very well contribute to our own well-being. Indeed, I have seen over and over throughout the past two decades of my career that people who are kind, honest and concerned as much about the well-being of others as themselves seem to stay younger in body and mind versus people who "have an edge". There's a lightness and a centeredness about them that surely contributes to that perception of youth and vitality.

There is a rich cornucopia of books out there on these subjects to suit every personality and taste. Gregg Braden's "The Divine Matrix" is a great place to start. A former aerospace computer systems designer, his writing never proselytizes but presents the reader with a feast of ideas to contemplate regarding just who we are.

An excellent way to bring your mind to a peaceful place is to meditate. My patients have sometimes said, "Oh, I can't do that -- my mind just starts to race". It's difficult for us, especially in our modern culture (although even Tibetan monks can have the problem) to completely quiet our minds. Know that you don't need to do anything formal like sitting in a particular position and you certainly don't need to reach a "goal". Sitting quietly for a few minutes and focusing on just listening to yourself breathe can be immensely calming. "Meditation" can even be losing yourself in a beautiful piece of music or stroking a beloved pet while appreciating what animals can teach us about unconditional love. Perhaps remembering an incident in your life when you felt particularly whole or fulfilled is a good way for you to begin. Anything that calms you or makes you feel peacefully happy, even if it's just for a few minutes here and there, is therapeutic.

Neurophysiologists have demonstrated that our brains have an amazing amount of "neuroplasticity" -- that we can continue to develop our brains throughout our lifetime. If you want absolute proof, log on to Lumosity.com and start training. It's very inexpensive, a lot of fun and you can track your progress with each session.

Aging is part of living; it's what we do because we are living. Attitude is one of the few elements of our lives over which we have control. Choose to see aging as the gift of living another day or another year. Choose to see aging as an opportunity to continue to grow rather than as a decline. The body you live in is precious. Give it the exercise it craves (certainly under a physician's care if you have any health issues) and the nutrients that make it healthy. Give your mind the benefit of healthy stimulation and your soul the elixir of a positive attitude. If it takes some discipline, that discipline will reward you many times over. Now that that's all solved, we'll talk later about having a face that reflects how vital and alive you feel!

To a certain extent – and within reason – that’s true. As you can well imagine, it’s certainly more likely that we’ll get a more youthful look with a more youthful patient. Regarding the longevity of the result, the more healthy the tissue on which we’re working, the more likely it is to retain the results of the surgery, and younger tissue often translates to more healthy tissue. Also, it has been shown that younger people generally tend to be happier with smaller levels of rejuvenation than older people are with even more dramatic levels of rejuvenation.

That being said, volume loss and sun-damaged skin are better treated with volume augmentation and lasers respectively than with a facelift. Both of these conditions tend to show up earlier than the conditions that are best treated with a facelift, those being the effects of gravity, accumulation of fat at the jowl areas, and stretching and shifting of connective tissues beneath the skin.

Remember too, that any invasive procedure will alter the anatomy somewhat. Structures are moved and stitched into a different position, and the nature of some of the operated tissue changes just by virtue of the natural healing process. So the fewer times someone has a lift over the course of their life, the lower the risk of complications.

Chronological age has less to do with age than individual genetics and lifestyle choices. I remember one day when I was operating, I had a 48 year old and a 64 year old back-to-back. The scrub nurse commented that even before the surgery, the 64 year old looked closer to 48 and the 48 year old looked closer to 64. The bottom line is that “how old” we look is becoming less and less a matter of numbers.

Lastly, make sure your doctor is someone whom you can trust to have your best interests in mind. A couple years ago I had a patient from out of town who had been told that she needed several things done including a facelift, and the fees came to well over $17,000. She was a beautiful, fit 36 year old with a slight genetic obliquity under her chin rather than the well-defined angle we associate with a young neck. She also had some early hooding at the upper lids and the beginning of some volume loss between her cheekbones and her nose. She had absolutely no indications for a facelift, much in keeping with most women that young. I gave her the contour she wanted at her neck, restored her upper lids and gave her some volume where she had lost it for way less than what she had been quoted and with much less invasiveness.